Vaccination gives pharmacists more ability to educate consumers about the flu, writes Karalyn Huxhagen
The flu season is well and truly here. Pharmacy vaccination services are increasingly being utilised across Australia with the opportunistic ability to be vaccinated being a key criteria that patients appreciate now that pharmacists can vaccinate.
Patients will present with a variety of symptoms and issues and they will often describe it as flu. Asking questions and gaining an understanding of the progression of the problem enables the pharmacist to discern whether the patient has the following:
- a cold;
- allergic rhinitis with/without bacterial infection; or
There needs to be consideration of whether the above conditions have morphed to secondary complications such as bacterial infection in the ears and sinuses; pneumonia, inflammation of the heart muscle, neurologic complications or bronchitis. Patients with conditions such as asthma or congestive heart failure may experience a worsening of their disease state due to the influenza virus.
Influenza or ‘the flu’ is a highly contagious disease caused by infection from influenza type A or B (or rarely C) virus. These viruses infect the upper airways and lungs.
The influenza virus can spread as a minor or major epidemic during the winter months. If a novel strain is introduced to a community it has the ability to cause a pandemic as the community may have a lack of immunity or the virus itself may be more virulent than previous strains.
Travellers returning from overseas countries may introduce a strain of influenza that is not covered in the current vaccine.
It is important to remember that vaccinated patients can contract influenza as non vaccine strains of the virus may be in the community or the patient may not have seroconverted after vaccination.
Influenza can be diagnosed via pathology and should be considered in patients who present as being very unwell or who have been unwell longer than three or four days. Symptoms of influenza can be similar to a bad cold but if aches and pains are present it is likely that the patient has influenza and not a cold.
The use of the neuraminidase inhibitors treatment for influenza comes with issues. The medication causes nausea and vomiting which can be severe. The medication should be started within 48 hours after the onset of symptoms, with the manufacturer recommending starting the treatment as early as possible to gain maximum benefit.
The evidence currently indicates that treatment only reduces the duration of symptoms by one day at best. Treatment should be given to patients who are at high risk of severe complications or even death from the influenza.
Treatment with neuraminidase inhibitors may reduce the risk of viral shedding and disease transmission. As such treatment should be considered for patients who are hospitalised, residents of an aged care facility or similar institution situation e.g. prisons, boarding schools or have household contacts that are at high risk of poor outcomes from influenza.
Neuraminidase inhibitors can be given after exposure to influenza if the patient cannot be vaccinated or if the current influenza vaccine that is available will not cover the strain of influenza that they have been exposed to. It is essential that post exposure prophylaxis is commenced within 48 hours after exposure.
When there is an outbreak in a community it is important to consider post exposure prophylaxis being given to health care workers and any other person who may have been exposed to the patient.
As influenza is transmitted via droplets exposure occurs easily. Droplets can remain viable on surfaces such as prescriptions and paper for up to seven days as the virus will live in the cellulose environment.
Infection control measures are essential when working with patients who may be positive carriers or influenza. Pharmacy staff need to be vigilant with infection control at all times as items such as prescriptions and money may contain virus droplets.
Patients cough, sneeze and breathe on surfaces while in the pharmacy. Regular cleaning of all surfaces with an antibacterial solution is important as well as regular hand cleaning.
All areas where patients are exchanging material with pharmacy staff should have access to antibacterial hand cleaner e.g. cash registers, prescription in and out counters, cosmetic counters and counselling areas.
Regular vaccination within a community with the current influenza vaccine increases the ability of the community to establish a ‘herd immunity’ status. It is possible for a person to enter a community after travelling and infect the community with a strain of influenza not covered by the current vaccine.
Vigilance by pharmacy staff to the possibility of an influenza outbreak is important. If the pharmacy is concerned about the number of customers presenting with influenza symptoms they should notify their local public health unit.
Yearly vaccination and practicing good hygiene techniques when exposed to people who are unwell are gold standards for prevention of influenza epidemics.
Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group.